The Organisational Dilemma
Tomorrow's organisations for the hard-of-hearing will
only become more influential if they provide more genuine value for
their members. You will only gain more members if you are perceived by
potential members as being an attractive and valuable group.
In many countries organisations for the hard-of-hearing
and organisations for the deaf are combined into one single
organisation. I see many good reasons for that, but I also see exactly
that organisational structure as one of the most important barriers
against expansion of the membership of the organisations for the
hard-of-hearing. People who have a hearing impairment (some may be
hearing aid users, others may not) are very sensitive to being called
deaf. They react emotionally against everything that has a connection to
being deaf. That's why they are less inclined to join an organisation
for the hard-of-hearing, if that organisation is also an organisation
for the deaf.
Therefore, I suggest that those organisations who are
combined both for the deaf and for the hearing impaired either separate
into two organisations with some structure for co-operation or at least
create two distinctly different divisions, each with their identity and
management. This is the only way the hard-of-hearing art can grow beyond
the narrow circles of today.
Consumer Organisations instead of Patient
Organisations
Hard-of-hearing people do not consider themselves as
patients. They want to see themselves as consumers. That is why they are
not inclined to join an organisation which acts like a patients'
organisation. Nobody is ashamed of being a consumer.
Therefore, I suggest that organisations for the
hard-of-hearing perceive themselves as consumer organisations. Their
profile in the community should reflect that fact, and the activities
that they perform should be presented in the consumer context. I am not
sure that this leads to discontinuation of any of the activities in
hard-of-hearing organisations of today, but I think it might and should
lead to a new focus on the hard-of-hearing person as a consumer.
It is also very important for the profile of
organisations for the hard-of-hearing that they are not run by
professionals. They should be run by the consumers - the hard-of-hearing
people themselves. Professionals are essential, but they should serve in
a supporting role.
What I Would Be Fighting For - if I Were You
I recognise that I do not lead an organisation for the
hard-of-hearing - I manage a hearing aid manufacturing company. However,
I have been invited to share with you what I would do if I were in your
shoes. I hope that you will see this as an inspiration and not as an
official statement, neither on behalf of European Manufacturers of
Hearing Aids or on behalf of Oticon. I speak in my own right.
If I were you I would fight particularly for:
-
Higher qualify of hearing care
-
Better methods for verification of quality hearing
care
-
More open and transparent competition
-
Better public subsidies for hearing care.
-
Education of General Practitioners and Ear, Nose
& Throat Doctors
-
Separation of the ENT-doctor and hearing aid fitting
Let me comment briefly on each of those six points:
Higher quality of hearing care
Despite all the knowledge that has been generated in the
scientific community during the past ten years I am sorry to say that I
think that the majority of all hearing care being provided today is
provided more on a "common sense basis" than on a sound
scientific and clinical basis.
Many hearing care providers lack a consistent
methodology for the hearing care process, and those who follow a
specific methodology do not in many cases have a sound scientific or
clinical basis for what they are doing. We need to take hearing care
dispensing from what may be called a "common sense level" into
a more scientifically based or knowledge based level. This takes a major
effort from hearing aid manufacturers and from hearing aid fitters,
including in particular a major educational effort. Having said that it
goes without saying that many clinics obviously do a very good job, but
unfortunately, there may be even more clinics not doing
such a good job. They should be encouraged to do better, and they should
be given the appropriate resources to do so.
Better methods for verification of quality hearing
care
Maybe the most important obstacle for providing better
quality hearing care is the apparent lack of a generally accepted method
for verification of the outcome of hearing aid treatment. Unfortunately,
many clinics believe it is sufficient to do a real ear measurement in
which a theoretical target curve is compared to the actual performance
of the hearing aid. My point is that this method of verification is
important and valuable, but by no means sufficient. Just think of the
fact that this method actually works equally well if the patient is dead
or alive!
We need much better methods for assessing the
communication ability in various sorts of background noise and we need
to systematically evaluate the actual performance and satisfaction of
the user in their daily listening environments. Lately, questionnaires
for this purpose have been developed but I think everybody would agree
that we need to do much more work within this field. I accept that this
actually takes time and resources from hearing clinics, but if we do not
attempt to measure hearing aid treatment quality we will never actually
significantly increase that quality. That takes measurements.
More open and transparent competition
Unfortunately, on some markets in Europe there is very
limited public regulation of hearing aid fitting. In these markets in
particular there is a trend towards charging very high prices for the
smallest styles of hearing aids, particularly canals and CICs. These
prices in some cases do not reflect the value or the benefit that the
instruments provide. There are unfortunately examples where very cheap
standard circuits packaged in a very small standard shell are sold for
extremely high prices. Obviously this does not mean that all small
instruments are just standard circuits - some small instruments are very
high quality and certainly justify a higher price.
The reality is, however, that there is not always a
reasonable connection between the benefit to the user and the cost
charged. The reason why this can happen is that the user in most cases
does not have a realistic possibility to compare two solutions. If
comparisons apply, most often they take place in unrealistic laboratory
conditions which are very far from the actual listening environments of
the user.
Consumer organisations such as the IFHOH members should
press for more open competition in which the user is informed properly
and in which the user is given a realistic choice.
Public subsidies
The fourth point I would fight for is better public
subsidies for hearing care. T me, there is little doubt that an
investment in hearing care from the society's point of view is a very
good one. Hearing care is inexpensive, the likelihood of successful
rehabilitation is high, and the social consequences of inadequate or too
late rehabilitation are considerable. EHIMA - the European Hearing
Instrument Manufacturers' Association - has just initiated a study which
is aimed at documenting the value of hearing aid treatment from a health
economic point of view.
In those cases where government subsidies are not able
to reach a level which covers the use of advanced hearing instruments I
would fight for a top-up system: a fixed subsidy, perhaps depending on
hearing loss, and an opportunity for the individual who can afford to
pay an additional amount to get a better solution.
Education of General Practitioners and Ear, Nose
& Throat Doctors
Throughout Europe and in fact, throughout the world,
general practitioners and ENT-doctors are not very well informed about
hearing aids. Most ENT-doctors have not had much training in hearing aid
fitting and the knowledge they have is in many cases outdated. There is
a great need for more and better information about modern diagnostic
techniques and modern hearing aid technology. I do not think it is a
role of consumer organisations to provide this information, but consumer
organisations should urge manufacturers, dispensers and governments to
increase the efforts of ongoing education and information to GPs and
ENTs. More knowledge is required for ENT-doctors to realise that all
hearing aids are not the same.
Separation of the ENT-doctor and hearing aid fitting
In some countries unfortunately there is a trend towards
ENT-doctors being more and more pressed for revenues which may lead them
to start dispensing hearing aids. Unfortunately, there are many examples
of ENT-doctors applying a relatively inexperienced person to fit hearing
aids without the necessary focus on the complete rehabilitation process,
which is a long term task.
I believe hard-of-hearing organisations should fight for
good co-operation between doctors and dispensers but each part has its
own expertise and I think the two parts play very different roles that
cannot easily be combined.
How Do the Manufacturers Get Concrete Influence in
Europe?
Let me finish by briefly outlining what the hearing
instrument manufacturers are doing to get more influence on the European
scene.
First of all manufacturers tend to give co-operation at
the European level a high priority. The manufacturers have shown
willingness to put financial means behind their co-operation by
establishing a small, but highly efficient secretariat in Brussels.
Without the secretariat I do not think that the manufacturers could have
achieved the results that they have achieved in Europe. We must admit
that a secretariat does require a financial commitment, but if we do
want influence we must also put our power behind it.
The second point is that the manufacturers have decided
to co-operate on specific projects, some of which have failed and some
of which have succeeded. Projects include standardisation, information
on hearing problems and hearing aids to the general public, interference
between GSM phones and hearing aids, and the above mentioned study on
the benefits of hearing aids. When manufacturers work together on
concrete projects they get to know each other and this often leads to
other sorts of co-operation which may not include all manufacturers.
Examples of this additional co-operation is HIMSA, The Hearing
Instrument Manufacturers Standards Association, and HIMPP, The Hearing
Instrument Manufacturers Patent Partnership.
Until now, there has not been much dialogue between
hearing instrument manufacturers and the consumer organisations within
IFHOH. I would like to propose that you view the industry as an
important partner in your work. You should realise that in order to
achieve a partnership on equal terms, one party must not only ask the
other what they can do for him, but both parties would have to
contribute in order to achieve a good co-operation on equal terms.
Therefore, I urge you not only to think of what the hearing instrument
manufacturers could do for you, but also what you could do for the
hearing instrument manufacturers. Consistent pressure for higher quality
hearing care is very much in the interest of both manufacturers,
dispensers and consumers.
Hellerup, June 6, 1997
Lars Kolind
